410
A further PREM questionnaire was developed in a larger cohort of patients with
RA [ 60 ]. This was developed after focus group discussions and piloted on 524
patients in different UK settings (Appendix 2).
Effective Use of PREMs for Improving Services: A UK
Perspective
The UK Department of Health has produced a practical guide to aid use of patient
experience to improve service quality: “Understanding What Matters: A Guide to
Using Patient Feedback to Transform Services” [ 61 ]. The guide includes an experi-
ence feedback cycle that describes the process of collecting and analyzing patient
experience data to design and implement service improvements. There are several
issues that may impact routine incorporation and translation of patient experience
into service improvements. For example, the optimal method for delivery of
PREMs—postal versus online—remains to be established [ 49 ]. It is likely to be a
combination that allows the greatest patient choice to maximize patient engagement
and involvement. Another consideration is the use of multimedia technology to
enable capture of information from patients with limited literacy skills [ 62 ]. One
study suggests that computer touchscreen questionnaires were well accepted by RA
patients, with good data quality, reliability, and score agreement when compared
with standardized paper questionnaires [ 63 ]. The potential impact of literacy on
patient experience for diseases with a large element of self-management such as RA
should also be considered [ 64 ].
For data analysis, it may be relevant to adjust measures of patient experience for
case mix in order to correct for differences in patient characteristics not under the
control of providers. This would facilitate fair comparison among healthcare pro-
viders by estimating the scores providers would have received if serving a common
population [ 65 ]. Data analysis should also consider the link between expectations
and experience: What people expect from their healthcare, compared with their
experiences of it in practice, may infl uence their satisfaction with their care. There
is some evidence that patients who receive the healthcare they expect are likely to
recover better than patients who do not. An expectations questionnaire may provide
a useful tool to benchmark the extent to which expectations are being met and to
identify the types of expectations that are and are not being met, thus potentially
informing treatment policy and practices [ 66 ].
Patient interactions with staff who provide healthcare services will impact patient
experience of care, therefore staff training may be appropriate. A national survey of
training courses provided by higher education providers and healthcare organiza-
tions in England was administered to all 180 providers of higher education to stu-
dent/qualifi ed doctors, nurses, and allied health professionals, and all 390 National
Health Service trusts in England, as a single question to the NHS 2010 Staff Survey
( n = 306,000) relating to the training staff had received to deliver a good patient
M. Bukhari